MONTGOMERY COUNTY BUSINESS LICENSE APPLICATION 
                                     101 S. Lawrence Street, Montgomery, AL 36104 
                                                                           (334) 832-1248 
                                                                                   
1. Business Name:            ____________________________________________________________________________________________________________ 
 
    Mailing Address:         ____________________________________________________________________________________________________________ 
    City:                    ____________________________________________ State: ________________________________ Zip:____________________ 
    Physical Address:        ____________________________________________________________________________________________________________ 
    Is business inside the city limits? (Please check one)                         Yes                          No 
2.  Business Phone:          _________________________________________ 
3.  Is this a home based business?                                                                                 
                                                             (Please check one)    Yes                 No
4.  Briefly describe business:  _______________________________________________________________________________________________________________ 
5.  Date Business Opened in Montgomery County:  ___________________________ 
6.  Business Type:  
                  (Please check one) 
 
                              Sole Proprietor                              Social Security No. _______________________________ 
                              Partnership                                  Federal I.D. No.       _______________________________ 
                              Corporation 
7.  Business or Owner’s Email Address:  ________________________________________ 
 
8.  Owner’s Name              Title                           Address                                                                Telephone # 
  ____________________________________  _______________  ____________________________________________________________  __________________________ 
  ____________________________________  _______________  ____________________________________________________________  __________________________ 
  ____________________________________  _______________  ____________________________________________________________  __________________________ 
  ____________________________________  _______________  ____________________________________________________________  __________________________ 
9.  SALES – Retail or Wholesale 
  Do you have a license to sell in another county in Alabama? (Please check one)                                                   Yes                                No          
  
      Fixed Location (Permanent) or Transient ____________________
  (check all items you sell) 
                                                              Bicycles             Tobacco                                           Electronics 
   
                                                              Computers            Magazines                                         Playing Cards 
                                                              Cell Phones          Appliances                                         
                                                              Auto Accessories     Soft Drinks 
 
10. CONTRACTOR SERVICES (Paint, construction, roofing, etc.) 
                                                                                                                                        
  Do you have a valid Section 84 (contractor’s license) in another county in Alabama? (Please check one)                                                        Yes                    No 
  (Note:  If you have answered “Yes”, please contact us at 334-832-1248 before proceeding.) 
 
  Provide an estimate of gross receipts in the State of Alabama for fiscal tax year:                                               $_________________________ 
                                                                                                                                     (SUBJECT TO AUDIT)   
  (Fiscal period – October 1 – September 30)                                                                                       
 
11. Additional Permits Required for:
                                                              
  Food Service, Auto Dealer, Auctioneer or Second County Transient 
                                                                                  Bond #:                         ___________________________ 
                                                                                  Regulatory License#:            ___________________________ 
                                                                                  Health Permit#:                 ___________________________ 
                                                                                  First County:                   ___________________________ 
 
12.  I declare under penalty of perjury that the above information is true and correct. 
 
  ________________________________________________________________                         ___________________________
                                                                                                                                                
    Signature of owner or authorized agent                                                        Date 
                  
                                                                                                   OFFICE USE ONLY                                                  ________________ 
                                                                                                                                            Clerk 
  Section                                                Fee              Section                                  Fee                               
  ___________________________________     _____________                   _________________________________   ______________            __________________ 
  ___________________________________     _____________                   _________________________________   ______________                  License# 
  ___________________________________     _____________                   _________________________________   ______________                   
                                                                                                                                    __________________ 
                                                                                                                                                                ID#